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Attention Deficit Hyperactivity Disorder Archive 2014

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Shari Gent, M.S.,
Educational Specialist

Shari Gent, M.S. is an education specialist with eighteen years of teaching experience. She has taught a diversity of students including those with learning handicaps, mental retardation, and autism spectrum disorders in both urban and rural environments. Her special interest is working with children with attention deficit disorder and associated mental health conditions. Shari has appeared on National Public Radio with leading experts in the field of attention deficit disorder. In addition to her professional work, she is a chapter coordinator for Children and Adults with Attention Deficit Disorder (CHADD) and parents a teenager with AD/HD.

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  • Support for elementary school student with ADHD and anxiety

Question:

Hello Shari-

I have a third grade student who has been diagnosed with ADHD and has difficulty relating socially to others, especially when we have a substitute or other change from our usual day. He is easily upset, seems to get anxious, and flaps his hands or tantrums. For example, the other day during math, the principal came on the PA system to make an announcement and this student jumped up out of his seat, flapping his hands and screaming to the class, “I can’t hear! I can’t hear!” How can I teach him to relate appropriately?

Edison, third grade teacher


Answer:

Hello Edison-

The combination of ADHD with co-existing anxiety can be challenging. The student with ADHD is often impulsive which when combined with the fears associated with anxiety results in significant acting out behavior. When working with a child who has an emotional disorder such as anxiety, focus first on developing self-awareness before moving to self-control and finally to appropriate social expression.

When teaching self-awareness about emotional difficulties, help your student become aware of how the feeling is manifested physically in his/her body. One way to do this is by taking a digital photo of your student when he is feeling the target emotion, in this case, anxiety. This may be difficult for you to do yourself when teaching though you can try. Otherwise, enlist the assistance of a paraprofessional, counselor, school psychologist, or other supportive adult. Then have the student role play the emotion. Brainstorm with your student ways that he can cope with his anxiety in a positive way.

Because the arousal of anxiety can be mild, moderate or severe, consider constructing an emotional thermometer to help your student visualize how his anxiety develops. One example of an emotional thermometer is pictured here:

Using a visualization like the thermometer helps the student predict what may happen if the anxiety increases and regain control. On the left side of this chart, you and the student record the stress signals. On the right side, record what actions you and the student have brainstormed to help him calm down. In young children, such as your third grader, you may want to take a digital photo for each level and paste in place of writing down the stress signals. When an individual, particularly a child, is feeling anxiety, the emotion may overwhelm rational thinking and seeing a picture will provide faster recognition than reading a list or several sentences.

One excellent teacher I worked with recently, had a student who was about the same age as your student and was very bright. The teacher came up with the idea to attaché the emotional thermometer to the inside cover of a “Feelings Journal.” Following any emotional outburst or appropriate use of the thermometer, the student was encouraged to draw or write in his journal. This assisted the student in self-evaluation of the incident.

You may also consider preparing the student for keeping a record by going through a list of daily activities and have him identify how stressful each event is by placing a post-it on the thermometer at the corresponding level of anxiety. For example, your student may feel at his calmest at recess or during silent reading and at his most anxious during the bus ride home. This can help your student think ahead and prepare for those events where he might become anxious.

Finally, most young children will find implementation of this system to require effort at first. The system will be most effective when your student receives positive verbal recognition and some sort of external reward (token, activity, or tangible) for using the thermometer successfully.

Additional Resources:

Buron, K. The Incredible 5-Point Scale. also When My Worries Get Too Big: Proactive Strategies for Supporting Highly Anxious Children. http://www.5pointscale.com/

Kuypers, L. The Zones of Regulation. http://www.zonesofregulation.com/the-book.html

  • How to Manage Fidgety Behavior


Question:

Hello, Shari-

A first grade student in my special education classroom has ADHD and has difficulty sitting still during large group activities and independent work time. He puts his hands in his mouth, rocks in his chair and taps his desk. How can I get him to pay attention?

Lisa, Special Education Teacher


Answer:

Students with ADHD have difficulty tolerating activities that may be perceived as boring and routine and require mental effort. They are often regarded as “sensory seeking” – needing sensory input in order to concentrate. Pencil and paper tasks and classroom activities that involve extensive listening are often extremely challenging. Left to themselves, students with ADHD will often find their own way to get sensory input when they are bored. This might involve rocking in their seat, tapping pencils, playing with objects or other fidgeting behaviors.

Not so long ago, teachers and researchers believed that we needed to “extinguish” or stop these behaviors so these students can concentrate. However, a study in 2009 changed the way we treat fidgety behavior. Dr. Mark Rapport, of Central Florida University, studied 23 pre-teen boys. He found that moving around helped the twelve boys with ADHD be more successful on tasks involving working memory. Dr. Rapport concluded that the ADHD boys were “under aroused.” Their brains did not produce enough dopamine to keep them alert. When activities were inherently more pleasurable, such as playing a videogame or watching an exciting movie, the boys were able to concentrate.

Transfer this principle to the classroom by experimenting with fidgets when a student’s self-stimulation is disruptive to others. Not all fidgets are for every child and fidgets do not address every movement problem, so you will need to individualize. When evaluating fidget toys, consider:

  • Safety
  • Size
  • Cost
  • Distractibility to others

ADHD children tend to tire easily of any single toy. To avoid this problem, keep groups of toys in several boxes and rotate these, perhaps weekly, giving your student a choice of toys from the box each time. Have the student use the fidget for specific short periods of time that are most problematic. You may need to have more than one fidget choice period.

Fidgets can be purchased online or created from readily available materials. Some ideas for homemade fidgets are:

  • Rubber band chains
  • Several butterfly paperclips clipped together on a binder ring
  • Bean bag made from scrap material filled with beans or rice
  • Rubik’s cube
  • Clothes pins
  • Heavy balloon filled with cornstarch
  • Soft round “worry stones”
  • Slinky
  • Snow globe
  • Silly drinking straws

There are many resources for fidgets online. Therapy Shoppe (www.therapyshoppe.com) conveniently categorizes fidgets into groups:

  • Alerting fidgets
  • Calming fidgets
  • Chewy fidgets
  • Tactile fidgets
  • Stress balls
  • Silent classroom fidgets

Additional sites include:


  • Qualifying for Section 504 accommodations

Question:

Can a middle school deny me a 504 meeting if my daughter have a diagnosis of ADD?

Apparently, my daughter's school is giving me the run around. They first want an S.S.T. meeting, etc. I am a middle school counselor in another district... That's not how we operate.

Thanks,

Stacy


Answer:

Hello Stacy,

School districts are given some latitude to craft their own process in Section 504 of the Rehabilitation Act of 1973. A medical diagnosis of ADHD is helpful but not necessarily sufficient in determining eligibility for accommodations or special education services. In addition to a diagnosis, the child needs to demonstrate a need for accommodations. The intent of the law is to provide access to the core curriculum regardless of disability. The Civil Rights Act of 1973 states:

“No otherwise qualified individual with a disability in the United States, as defined in §706(8) of this title, shall, solely by reason of her or his disability, be excluded from the participation in, be denied the benefits of, or be subjected to discrimination under any program or activity receiving Federal financial assistance…”
29 USC§794(a)
34 CFR §104.4(a

Section 504 defines “disabled person” as one who:

  • Has a physical or mental impairment which substantially limits one or more major life activity;
  • Has a record of such impairment, or;
  • Is regarded as having such an impairment.

In addition to basic bodily functions, walking, talking breathing, or caring for oneself, the 2008 amendment considers major life activities to also include learning, reading, concentrating, thinking, and communicating.

Having a diagnosis does not mean a person is “disabled” under the law. The definition of “disability” indicates that a physical or mental condition must “substantially limit” participation in a “major life activity.” The term “substantially limits” is not defined in the law. However, in a letter the Office of Civil Rights has stated, “this is a determination to be made by each local school district and depends on the nature and severity of the person’s disabling condition.” If a student is demonstrating that that she is unable to learn at the level of the typical student because of her disability, she may be eligible. Since 2008, school districts need to consider eligibility without “mitigating factors.” This means that the severity of a child’s disability must be considered without the benefit of medication or other mitigating measures such as learned behavioral or adaptive neurological modifications, assistive technology or accommodations. Some districts find that if a child is achieving within the range of the average student, she is not demonstrating a handicap in relation to the typical child. As a parent, you can request that the school determine eligibility. Steps to take are:

  • Put your concerns in writing. Write a letter to the school to request an evaluation to determine eligibility.
  • Request a copy of your daughter’s school district’s policies and procedures regarding Section 504. School districts vary in the way they implement Section 504.

Unlike consideration for special education under IDEA 2008, schools are not required to include parents as part of the decision-making team. It’s been my experience that most districts like to include families. However, they are free to schedule the meeting at a time during school that does not necessarily include the parent’s scheduling needs, although any information and reports a parent may have, should be considered. At the eligibility determination meeting, the school should consider information from a variety of resources, not just a single source. Parents must be informed that the meeting will occur and must also be provided a copy of any accommodations plan that results.

Should parents disagree with the results of the evaluation, they have the right to file a complaint with the Office of Civil Rights or to request a due process hearing. The school is not required to provide an independent educational evaluation.

For additional information:

Durheim, M. A Parents’ Guide to Section 504 in Public Schools. Great Schools.
http://www.greatschools.org/special-education/legal-rights/868-section-504.gs?content=868

CHADD National Resource Center on ADHD. “Educational Rights.”
http://www.help4adhd.org/en/education/rights/504


  • Homework strategies for ADHD elementary students

Question:

Hi there!

I have two elementary aged daughters with ADHD. Medication has significantly helped. By the time they are home (after my work day 4-5ish) their medication has worn off. They get a snack and some down time, but when it’s time to do homework it’s often very difficult for them to pay attention. My older (10) daughter can rarely focus and my younger one (8yrs old) is defiant even with rewards set in place. She is a struggle to work with. We give breaks but her transition time it terrible. I am planning to implement a video model for her as well as a reward chart. Any suggestions you might have would be great.

Thank you!
Jennifer


Answer:

Hello Jennifer,

Homework can really be a sticky issue for students with ADHD and the source of family conflict. Problems with organizational skills continue throughout the lifespan for individuals with ADHD, but intervening early can improve the outcome.

Start by checking to be sure the homework expectations are appropriate for your daughters’ age and the time they are able to attend. Research indicates that about ten minutes per grade level is appropriate for homework or independent seatwork. Most students with ADHD are 3-4 years below their grade level developmentally in terms of attention span and social maturity. Based on this, appropriate expectations for your ten year old, rather than being 50 minutes of homework would be 30-35 minutes of homework. Expect your eight year-old to be able to attend for 15-20 minutes.

In addition, look at the content and type of task assigned. Most experts agree that until high school, the purpose of homework should be to teach personal responsibility. Until then, students should be receiving instruction on new information and skills at school and homework should be reserved for practicing material already mastered. Your first step should be to talk with your daughters’ teachers and be sure expectations are realistic for your daughters’ development for attending time and for task requirement. You may need to request additional accommodations if these basic expectations are not met.

If the time requirements seem appropriate and your daughters still have difficulty sitting, you may need to break the time up into one or two attainable sessions. Start by determining just how long your daughters can each realistically work. Time them to see how long they can work each day for three days, then average that time to calculate how long a homework session should be. If your oldest daughter is able to work on her own for about ten minutes, you may have to break the homework up into three sessions. You mentioned that your daughters have difficulty transitioning to and from a break. Consider setting a timer for the break time. I like to have my students set the timer themselves and let me know when their break time is over. Have a menu of rewarding, but not too rewarding, activities for them to do during their break. Screen time is an example of an activity that may be too rewarding to encourage a return to homework. Appropriate break activities might be taking a jog around the yard, jump roping, dancing to some music and returning when the music stops. Exercise helps increase brain activity and kids are often ready to stop to rest after just a short period of time. Also, structure homework periods so that the most interesting and desirable activities are reserved for last. Talk with her teacher about limiting worksheets and including hands-on and practical activities as part of the assignment.

Finally, consider consulting your daughters’ pediatrician about adjusting or adding medication so that the girls are on medication during the homework period. This is commonly requested by families, especially as homework demands become greater in middle school. Also, be sure the area of the home where they work is free of distractions and is quiet. Experiment with playing quiet classical music to help them to focus better. Be sure that all homework materials are available and easy to access immediately. For example, keep poster board available at home for projects in case your daughters don’t think to ask for it until the last minute.

Perform backpack checks as your children get home and before school each day to be sure they have their assignments and needed texts. Finally, communicate with the classroom teachers frequently- every day if needed- about how much work and how long they were able to work. If this is a formal communication, the teacher will not be surprised if you ask for additional or different accommodations.

Research indicates that students with ADHD benefit from being taught executive function skills. Researchers at the New York University Child Study Center have identified key skills that most students with ADHD lack: tracking assignments, managing materials, time management, and task planning. If you are fortunate enough to have a close relationship with an educational therapist or with your children’s special education teachers, you might be interesting in working together to implement the research supported program, “Organizational Skills Training for Children with ADHD” developed by Drs. Richard Gallagher, Howard Abikoff, and Elana Spira at the New York Child Center. This 20-week program has demonstrated success in teaching children with ADHD to focus and stay organized with homework. The program requires participation by and close cooperation between home and school.

For more information:

New York University Child Study Center. www.aboutourkids.org

Gallagher, R., Abikoff, H., Spira, E. (2014) Organizational Skills Training for Children with ADHD: An Empirically Supported Treatment. New York, NY: The Guilford Press.

Thank you for your questions,

Shari


  • ADHD and Common Core State Standards

Question:

Hi, Shari-

I am a resource specialist serving students with mild to moderate disabilities. I would say that about two-thirds of my students have ADHD. All of the teachers are facing challenges in implementing the new Common Core State Standards (CCSS). This is particularly difficult with students who have attention and other behavioral difficulties. So much cooperation and discussion is required! I don’t know how our special education students will cope. Do you have any suggestions on how to integrate specialized instruction with CCSS?

Fran, RSP
Lake County


Answer:

Hello Fran-

I don’t envy you. CCSS is a big adjustment for most educators. But hold onto your hat, the ride isn’t as rocky as it seems.

Rather than being a pitfall, the new standards may actually hold promise for students with ADHD. Significant changes in the standards revolve around increased emphasis on critical thinking in both English Language Arts (ELA) and in Mathematics. Many students with ADHD have intact reasoning abilities and may do quite well with abstract thinking and problem-solving, given structure. Special educators like you are generally quite knowledgeable about ways to structure for success.

The two key issues that are barriers for students with ADHD are executive function and social interaction difficulties. Students who are in general education for most of the day need to be exposed to instruction based in CCSS. The good news is that general education teachers are encouraged to adapt for diverse learners through differentiations of instruction. Many resources are available to assist teachers to create multiple means of representation, multiple means of expression and multiple means of engagement. In fact, if you use Universal Design principles, executive function and academic engagement are issues that are explicitly addressed. The Center for Applied Special Technology (CAST) has a plethora of resources in both areas, including specific instructional strategies and materials to address executive function weaknesses. A free downloadable PDF book on Universal Design is available at www.cast.org. Click on “About UDL” for access to teaching resources and the UDL Guidelines chart. Here are the basics, with reference to executive function highlighted:

Should the student need an individualized education program involving modifications, scaffolding the new CCSS standards to address the present level of performance is not significantly different from scaffolding the old standards; always base goals and objectives in the grade level standard. The basic steps for scaffolding are:

  1. Determine the present level of performance.
  2. Choose the priority standard that addresses the student’s barriers to learning
  3. “Unpack” the standard
  4. Analyze the sub skills
  5. Develop the goal
  6. Monitor the progress (required 3-4 times yearly)

“Unpacking” the standard involves:

  1. Paraphrase the standard. Determine the “essence.”
  2. Determine the purpose for the standard. Why do we do it?
  3. Identify the skills the student will need in order to meet the standard.

The language of the Common Core includes verbs that allude to executive function and social emotional learning skills. Kevin Shaeffer of West Ed has surveyed the ELA standards and identified verbs related to executive function and communication. Social skills are primarily related to communication skills. As a resource specialist, when you design a goal addressing a standard for a student with ADHD, you can also create a goal that involves teaching an executive function skill by using verbs that he has highlighted. You can download the highlighted CCSS at: http://cde.videossc.com/archives/032114/ Look at the sidebar on the right and click on “CCSS Goal Writing Document” for the PDF.

Verbs indicate what the students are expected to do. Executive function verbs are highlighted in red and communication verbs are highlighted in blue. An example of a standard which involves executive function is:

“Activate prior knowledge related to the information and events in a text.” (RL1.10)

Using working memory, students must hold the topic at hand in mind as they explore their previous experience.

Resources:

Achieve the Core http://www.achievethecore.org/

CA Brokers of Expertise
California Common CORE State Standards Professional Learning Modules
www.myboe.org

California Department of Education: Common Core State Standards

California Department of Education: Special Education: Services and Resources
http://www.cde.ca.gov/sp/se/sr/

Common Core State Standards Initiative http://www.corestandards.org/
Kevin Shaeffers’s Common Core Standards and Writing IEP Goals, 2 from http://cde.videossc.com/archives/032114/

Universal Design. www.cast.org


  • Accommodations to assist with finishing high school

Question:

Hi Shari-

My seventeen year-old-daughter has ADHD and receives accommodations. She is a senior in high school and had planned to graduate this year. She is taking courses at our local community college and has already been admitted to college for next year. She has always struggled to complete her schoolwork, especially homework. She does really well on tests. However, this year her grades have plummeted because she is turning in even less work than usual. She has says that she doesn’t see the point of doing her homework or even graduating high school since she is already in community college. Is this true? Can she go right into community college without graduating high school? If not, what accommodations can I ask the school to give her that will support her in completing her work?

Worried Mom


Answer:

Dear Worried,

Take heart- your daughter is bravely, if somewhat impulsively, testing her wings. I have consulted with our transition specialist about this and she agrees – it actually is possible to attend community college and earn an A.A. degree without graduating high school. However, this is probably not the wisest way to go about getting a college degree. Your daughter will have more opportunities and options if she has a high school diploma as well as a community college degree.

As the parent of an older teen, you are probably becoming familiar with your new role – that of “parent-coach and chief cheerleader.” Your daughter likely is not fully aware of the consequences of the decision she will make. Since it may be difficult for you and your daughter to avoid focusing on personal issues when discussing this, you may want to enlist the assistance of a guidance counselor, ADHD coach, or, if appropriate, a family therapist. Even having another family member or friend stand in as a third-party observer may be helpful.

When discussing options with your daughter, help her to see the pros and cons for each choice; consider listing them in writing as you discuss. Moving right to community college might seem to be a lot easier now, but this also might not give her the best advantage in the long run. On the pro side for getting a diploma, consider the fact that having a high school diploma will give her the opportunity to seek employment that requires a diploma while she is attending college. At some point, she may want a part-time job to supplement her income. Also, having a diploma gives her more flexibility in the time she takes to finish her A.A. degree.

Consider taking your daughter to visit the special services office at your community college to discuss how she might continue to receive accommodations in college. The law, Americans with Disabilities Act (ADA), and procedures to obtain accommodations differ significantly in post-secondary settings. Although college students are covered by Section 504 of the Civil Rights Act, unlike high schools, colleges are not required to provide a free, appropriate public education (FAPE) to all their students. For details about rights and responsibilities, check out the U.S. Department of Education website: http://www2.ed.gov/about/offices/list/ocr/transition.html

In addition, you and your daughter may want to visit these additional websites, recommended by our transition specialist, to more fully explore the requirements for her career interests:

California Career Zone www.cacareerzone.org

  • This site includes an interest survey titled Assess Yourself that helps to identify strengths.
  • Related occupations can be explored in the Explore Job Families section. Videos, education requirements, wages, job outlook and skills needed are covered
  • The section called, Getting a Reality Check, explores the money needed to pay for housing, transportation, food, clothing, etc.

O*Net Online www.onetonline.org

  • This is an interactive/information site for career exploration and job analysis.
  • O*Net Online has detailed descriptions of the world of work as well as inventories for your daughter to learn more about her work preferences.

When looking at accommodations for the remainder of high school, consider assigning less weight to daily assignments and long-term projects and more on tests results. Although homework at the secondary level is designed to teach through self -instructional, this may not be as important for the moment as passing the coursework. You may be able to lessen the percentage of her grade based on homework to a significant degree, as long as she is able to pass a test that demonstrates her knowledge. Finally, as a last option, your daughter may be willing to take the General Educational Development Test (GED.) Details about this test are available at the California Department of Education website: http://www.cde.ca.gov/ta/tg/gd/gedtest.asp